NHS App

“This is a huge overstatement of the likely impact of the app. “Although the app is undoubtedly good for patients, the fact that results can be easily seen also means an increase in some questions to GPs, particularly uncertainty what a test was, borderline results and a reduction in others where tests are normal. “In fact GPs are now getting questions about hospital tests, that they have not ordered, which would normally only be discussed at a hospital follow-up appointment. “It is likely the app is not saving appointments and certainly not in the numbers extrapolated by NHS England.” Dr Lizzie Toberty, DAUK’s GP lead, spoke to the i Paper about Government plans for changes to the benefits system.

General practice

Work and Pensions Secretary Liz Kendall has announced plans for GPs to refer patients to so-called employment advisers rather than being signed off sick. Dr Toberty said: “This might release GP appointments as some patients do book appointments to simply discuss a fit note again.” She added: “We do need a proper system which balances the challenges each individual is facing in returning to work and being fair to the taxpayer. “People on benefits are often among some of the most vulnerable in society and I have no doubt many will be fearful of what changes to the benefits system mean for them. “As a GP I welcome a scheme which is supportive, flexible and not punitive. I think the concern is when people feel their income is threatened it causes them to be stressed and more unwell. That’s why it needs to be done in a nuanced way.”

Elective care waits

Dr Taylor contributed to a GP Online article which reported on a National Audit Office report that found NHS England was not on track to achieve its target to end elective care waits of more than one year by March 2025. He said: ‘With more than 5m more appointments in GP practices every month compared to 2019, the delays in patient care is having a huge impact on primary care. “Complaints of lack of GP appointments are being exacerbated by poor hospital performance as patients are increasingly needing to access care while they wait, and more than half a million more long-term sick need support.’ He added: “Hospitals remain blocked with patients who could be better managed in the community, so it’s vital that there is a joined up approach with hospitals, community care and social care working together. It’s not one or the other, it’s all together.” Please support our work by contributing to our crowd funder or by becoming a member.

Contract announcement

Dr George, a GP based in Newcastle, told ITV Lunchtime News it was ‘a positive announcement’. She said: “It will go some way towards repairing the damage that has been done to general practice over the past 14 or 15 years with the chronic underfunding and diktats from the Department of Health and NHS England. “There is still someway to go. overall I think it is a positive announcement. It means we have space to move things forward and bring general practice back from the brink.” Dr Lizzie Toberty, our GP lead, who is also based in Newcastle, was interviewed on national radio.

General practice

She told listeners to LBC’s Tom Swarbrick at Drive: “For many years, we’ve not seen an uplift in funding for general practice. “Despite increases in the cost of living, increases in the amount of funding needed to pay staff, there hasn’t been an increase in the funding provided. “And yet we’ve seen our population grow. “General practice as a whole has been struggling to provide what our patients have needed. “I think (the agreement) provides a glimmer of hope for GPs and patients alike. “It’s the first day a contract has been agreed between our union and the government over the last four years which shows that both sides are working together to make things better.”

Running costs

Visit our Instagram page to listen to Dr Toberty speaking on LBC. Dr Steve Taylor, our GP spokesperson and a GP based in Manchester, spoke to BBC Online Dr Taylor said he feared much of the extra money will go towards national insurance contributions, staff, and running costs. He said: “The new GP contract goes a small way to fix some of the significant issues for GP practices, in that it prevents further declines in funding with a small percentage increase.” Dr Taylor was also quoted in GP Online. He said: “’While there has been an acknowledgment of the need to invest in community services, a much larger investment will be needed to reverse the decline and build more capacity for the future. We look forward to seeing greater emphasis placed on GP provision in the future years.” GPC England announced on Friday it had voted to accept the proposed contract. It includes an overall funding uplift of £969m for 2025/26, contingent on full renegotiation of the national contract within this parliament. Read the full headlines. Please support our work by contributing to our crowd funder or by becoming a member.

National Insurance contributions

“Sadly, much of the increase in funding will be lost to National Insurance contributions, staff and on costs. “While there has been an acknowledgment of the need to invest in community services, a much larger investment will be needed to reverse the decline and build more capacity for the future. “We look forward to seeing greater emphasis placed on GP provision in the future years. “We also hope that amendments to the legislation on National Insurance contributions for GP practices, recommended by the House of Lords, will be implemented without a cut in this proposed budget.” His comments come as GPC England voted to accept the proposed contract, which includes an overall funding uplift of £969m for 2025/26, contingent on full renegotiation of the national contract within this parliament.

Contract changes

Key headlines from the 25-26 GP contract changes:

• £969 million new investment uplift – comprises £889m additional core contract funding and £80m for use of e-RS advice and guidance between GPs and consultants.
• This investment is on top of the £433m added to the contract during autumn last year.
• Enhancement of ARRS, with GPs and practice nurses added in to the main scheme, minimum GP salary + on-cost reimbursement increased in line with the BMA salaried GP pay range and with no caps on numbers
• Enhanced service for ‘pre-referral’ advice and guidance with a £20 item of service fee payment per request by GPs
• Restoration / uplift of SFE payments (sickness/parental leave cover) in line with 2025-26 real-terms values (compared to 2018/19), including locum reimbursements and childhood vaccination payments.
• Changes to requirements for patient online e-consultation access to general practice from October 2025

Continuity of care

Dr Lizzie Toberty, DAUK GP lead, said: “We welcome the Government’s emphasis on continuity of care and patients being able to see the same doctor. “This is how high quality care which facilitates the move from hospital to community can happen, and there are huge efficiencies to be gained as well.” Dr Rosie Shire, DAUK GP committee member, added: “The move to increase ARRS (Additional Roles Reimbursement Scheme) funding for GPs is helpful.

ARRS posts

“However, it is not clear if GP ARRS posts are going to be open to experienced GPs as well, or whether they will continue to be restricted to those within two years of qualifying. “We have thousands of GPs out of work and struggling to find work, and practices need to be able to employ the GPs they need. “Funding GPs, who can give patients continuity of care, is the best use of the ARRS funds and will keep more patients out of hospital.” Please support our work by contributing to our crowd funder or by becoming a member.

GP crisis

The launch brought together key stakeholders and professionals from across primary care, as well as MPs. Stakeholders included general practice leaders from the BMA, Royal College of General Practice (RCGP), the Institute for General Practice Management (IGPM), and campaigners from Rebuild General Practice. Speaking to Pulse, one of Cogora’s publications, Dr Taylor said the white paper was ‘important’ “There are unemployed GPs and practices can’t afford to employ those GPs,” he said. “Without the funding, there will be fewer doctors and it will take us in the wrong direction. “And this is an emergency that needs to be dealt with in the next 12 to 18 months. It can’t wait for another five to 10 years. “General practice gets such a small proportion of the NHS budget and there is flexibility to correct this.”

GP funding

Dr Toberty added: “It is absolutely possible to find that funding for general practice within that timeframe. “Because there is money there, it is in the ARRS, which is unevidenced and there is a growing feeling that it isn’t providing value for money. “A better way would be to return that money into core funding to allow practices to flex their workforce to their local population. This isn’t a hopeless situation.” Read the full report, called the Cogora General Practice Workforce White Paper. We are a non-profit organisation led by frontline doctors, for frontline doctors. Our collective aim is to give frontline workers a voice. Please support our work by contributing to our crowd funder or by becoming a member.

Work with GPs

“Government needs to work with GPs urgently.” Dr Taylor highlighted an NHS England document in which an example of a reformed elective pathway for ear, nose, and throat (ENT) was cited. In the example, the patient, Sarah, is seen by a nurse practitioner, referred for a CT scan at a community diagnostic hub, before her results are discussed by the nurse practitioner and an ENT registrar. Dr Taylor said: “I’m pretty sure if Sarah had seen a GP she wouldn’t have needed to have a CT scan, no need to speak to the ENT registrar and, yes, it could be managed in the community “Why does NHS England always underestimate the skills of GPs?” DAUK GP committee member Dr Alison George added: “What a waste of time, money, and resources, and of course a patient having unnecessary ionising radiation.

Unemployed GPs

“Why won’t the Department for Health just fund the employment of approximately 3,500 under and unemployed GPs so they can offer the holistic, expert generalist care that patients so desperately need and is in fact extremely good value for money? “Remove physician associates from ARRS (additional roles reimbursement scheme). Put the funding back into the core budget. Allow practices to employ the GPs they want, so they can offer more patients the care they need and deserve.” Speaking on Times Radio, Dr Taylor welcomed the Government’s attempts to reduce waiting lists, but questioned the thinking behind some of the proposals. He said: “They’ve put forward a huge number of ideas, and you have to applaud them for coming up with some ideas. “Some of them are a very top down approach to finding solutions where they could have come up with more simple solutions. “Some of the things I’ve read make me wonder whether they’ve been written by somebody that’s got no idea of how to work in the NHS, certainly as a GP.

Patient choice

“One of the things they’ve suggested is patients should be given a choice of five different places they can go for their procedures, but if the waiting times for those places are long it doesn’t matter where they’re seen in Cornwall, London or Manchester. “Patients want their local hospital to be working for them.” And he questioned proposals to treat more patients in private clinics. He said: “If you spend more money using NHS budgets within the independent sector then clearly they can grow their margins. “They will grow from using NHS resources. “That’s the concern many people in the NHS have, they would love to see that money invested in the NHS in the first place.”

Lack of capacity

Dr Sarah Jacques, DAUK GP committee member, said the proposals looked like increasing the work and responsibility of primary care, ‘which lacks the capacity to deal with it all’. She said: “GPs will be able to order lots more highly-specialist tests that we won’t really know how to interpret, don’t have the capacity to follow up, don’t have the expert knowledge to action, and don’t have access to consequent procedures to treat patients. “People’s quality of care is not going to improve.” Dr Ellen Welch, DAUK vice chair, added: “The big question is who is going to staff these community diagnostic centres and surgical hubs and where are they taking them from to do so? “And who will analyse these tests? GPs, no doubt.

Staffing crisis

“We already have a staffing crisis in general practice, without adding even more to our workloads. “We need to see more of the detail, but on first look it looks like a massive dump onto general practice again.” Dr Lizzie Toberty, DAUK GP lead, said: “Funding is the crux of it all. We’ve seen general practice funding cut by a fifth but we’re being expected to do more and more – and now the proposals are for even more work to shift to primary care. “We’ve got thousands of GPs who are unemployed or underemployed. By funding general practice properly, those extra GPs can help keep people out of hospital and ease the strain on the rest of the NHS.” Please support our work by becoming a member or donating to our Go Fund Me. Read more about the Government’s plans.

GP employment

“And we remain very concerned about the implications of the ongoing employment of GPs through the additional role reimbursement scheme (ARRS). “We need more detail and are concerned this is nothing more than smoke and mirrors.” Dr Steve Taylor, DAUK GP spokesperson: “We cautiously welcome the extra funding, but it fails to address the fact that general practice has had a 20 per cent real terms cut in funding per patient over the past eight years. “GPs are now doing 20 per cent more work than before the pandemic – so we’re doing much more for much less and it needs addressing. “The additional role reimbursement scheme (ARRS) GP recruitment programme is failing to meet the needs of underemployed GPs, particularly those looking for the security of permanent jobs in practices. “Depending on reports, there have been between 60 to 300 GPs employed by the scheme to date at huge expense.

GP funding

“The money would be better spent if it was put into core GP funding.” Dr Alison George, DAUK GP committee member, said: “The concern is that the Department for Health is trying to employ more GPs through ARRS, effectively making them employed by the government on low pay and poor working conditions. “There are around 3,500 full-time equivalent GPs available to work now. Why would the government refuse to fund jobs for them but continue to fund approximately 2,000 physician associates (PAs) in general practice? “Funding GPs, who can give patients holistic care, is the best use of the ARRS funds for PAs and will keep more patients out of hospital. “The money needs to be put back into core budgets and let practices employ the GPs they need.” Dr Ellen Welch, DAUK vice chair and a GP, said: “We have repeatedly called for ARRS funding to be reallocated to restore core GP funding – and do so again.

Darzi review

“Lord Darzi’s review pointed out GPs are the most financially disciplined part of the NHS, and we have the unbelievable situation where thousands of GPs are unemployed or underemployed. “The billions of pounds being spent on inefficient ARRS that fragment care should be reallocated into core general practice. “We need to be able to use our budgets to meet the needs of our patients and communities, and to increase GP numbers for safer ratios of patients to doctors.” Dr Sarah Jacques, DAUK GP committee member, said: “It’s a very uncertain time for practices with many being forced to close or on the brink of closure.

National Insurance contributions

“This money will all be eroded unless the government fully reimburses GPs for the increased National Insurance contributions and we see an uplift in the DDRB (the Review Body on Doctors’ and Dentists’ Remuneration) recommendation for GPs’ rates of pay. “Without those we’re set for another year of defunding.” Support our work by becoming a member or donating to our Go Fund Me. Read more on Mr Streeting’s announcement.

A copy of ‘Why Can’t I See My GP?’ and ‘The NHS: The Story so Far’ have been sent to every member of the Health Select Committee, and to all MPs who are doctors.

We’ve also sent them a letter and our updated manifesto, which we believe will go a long way to easing the crisis in general practice.

The books have been written by Dr Ellen Welch, a GP and vice chair of DAUK.

GP crisis

Dr Welch said: “General practice has been in crisis for some time now. The primary care workforce is shrinking, with almost 2,000 fewer GPs than in 2015.

“Funding for general practices has decreased by 20 per cent in the past eight years while workloads have increased. We’re doing much more for much less.

“Our estates are crumbling, our IT systems are falling down. The list goes on.

“Despite this, an average 1.4 million GP appointments are delivered every working day.

“Imagine what we could do with proper investment in primary care.

GP crisis solutions

“Which is why DAUK aims to put the crisis facing general practice high on the political agenda and provide workable and sustainable solutions.”

It comes as Health Secretary Wes Streeting announced in the Daily Telegraph, plans for a mass expansion of GP services. The plans include training thousands more GPs, health visitors, and community nurses.

Dr Welch welcomed the focus on primary care but said it was ‘a national scandal’ that thousands of general practitioners are struggling to find work while the country is in a GP jobs crisis.

Dr Welch said: “We have trained and experienced GPs telling us they’re working in supermarkets, driving taxis, and even signing on universal credit because there aren’t any jobs for them.

GP funding

“From our own research, potentially there are around 3,500 full-time equivalent GPs available if the funding that’s been cut from practices over the past eight to 10 years is restored.

“It’s not a shortage of GPs, it’s a shortage of funding, and it would take just £35 per patient per year to solve.

Dr Steve Taylor, DAUK GP spokesperson, added: “NHS England has moved funding into other roles via the Additional Roles Reimbursement Scheme (ARRS) at the expense of GPs. £100million has been invested in this scheme which has seen only 88 GPs employed.

“It would be used much more efficiently and effectively if general practices were free to use their budgets to meet the needs of their patients.”

ARRS staff

Dr Sarah Jacques, DAUK GP committee member, said “The use of ARRS staff was established to supposedly reduce the workload for GPs and improve patient care.

Unfortunately, most roles require supervision and have increased GP workload and fragmented patient care.

“The scheme is not cost efficient and not effective. The funding needs to go back into the core contract, so GPs can do what they do best by letting them provide holistic care with continuity.”

Dr Lizzie Toberty, DAUK’s GP lead, said ‘We have huge concerns about the increase in National Insurance employer contributions on GP practices, with many already at risk of closure due to financial constraints.

“GPs are the beating heart of the NHS and if more practices are forced to close it will be patients who ultimately suffer.”

Why Can’t I See My GP?

The book ‘Why Can’t I See My GP?’ walks readers through the state of general practice with passionate testimony from GPs who live and breathe the NHS.

It is full of personal accounts from GP leaders including Dr David Wrigley, the deputy chair of the BMA GP committee; Dr Lizzie Toberty, GP lead for DAUK; and Dr Paul Evans, GP and chair of Gateshead and North Tyneside LMC.

‘Why Can’t I See My GP?’ by Dr Welch is published by Calon/University of Wales Press. All royalties for the book are being donated to DAUK.

‘The NHS – The Story So Far’ is published by Pen & Sword Books and traces the history of our health service, from Victorian healthcare and the early 20th century, through a timeline of change to the current day.

Support our work by becoming a member or donating to our Go Fund Me.

Budget 2024

“As a result of that underfunding there are issues regarding pay, working conditions, staff shortages, training, access to jobs, buildings and estates, the list goes on. “And the Government also needs to sort out social care. As Lord Darzi said in his review, the dire state of social care is one of the reasons the NHS is in a mess.” Ms Fernandes expressed concern that the rise in employer national insurance contributions, if extended to general practice, could have ‘dire consequences’ on practices. Ms Fernandes said: “GP surgeries are struggling to survive, with hundreds already closing their doors, and many general practitioners struggling to find work. “An increase in employer national insurance costs, if it was to include general practice, could have dire consequences and might well be the expense that makes many unviable. “A rise in employer costs is also likely to have an impact on recruitment and retention in social care, which in turn would have a detrimental effect on hospital admissions, discharges, and waiting lists. “The same with the rise in the national minimum wage. Of course we want to see people paid properly for the work they do, but it could have unintended consequences for general practice and social care.”

Primary care

DAUK’s GP lead Dr Lizzie Toberty said a large proportion of the new funding announced by the Chancellor should be directed towards primary care to help ease the pressure on hospitals and to move care to community settings. Dr Toberty said: “Following the Darzi Report and Wes Streeting’s stated desire to move care from hospitals to community, the money has to be spent in primary care. “Darzi said GPs had been the most fiscally responsible group within the NHS. Yet somehow we now have the utter catastrophe of qualified GPs without employment while patients are desperate to see a general practitioner. “Let’s get them back to work by investing funds in core general practice work.” Dr Toberty said the Additional Roles Reimbursement Scheme (ARRS) needed reforming. She said: “Millions of pounds of ARRS funding is sent back to the Treasury unspent every year. The Government needs to move ARRS into core funding. “We don’t need more GPs, we need employment for the ones we’ve got. “There also needs to be a shift from recruitment to retention. Reward NHS staff who stay firmly rooted in their communities and who provide the continuity which ultimately provides the most financially efficient and effective way to provide patient care.

Vital investment

“Investment is vital but money needs to be spent in the right places.” Dr Toberty added: “They also cannot focus on one size fits all solutions. “They need to trust local health systems to organise their own solutions without absurd rules set by Whitehall. “If they did this patients could see improvements in their access to a GP within weeks, presuming pre-employment checks could be carried out quickly.” And Dr Toberty said there needed to be a ‘huge shift’ in how the NHS values staff. She said: “Lord Darzi talked about loss of discretionary effort because staff “All the new scanners and surgical hubs require staff, not only to recruit but to retain. “The NHS has a poor reputation in this regard. “What is the government going to do to look after and value the staff they have?” Support the work of DAUK by donating to our Go Fund Me.

DAUK’s GP Committee stands ready to work with Wes Streeting on cutting bureaucracy and addressing issues with primary and secondary care communication.

It follows a speech by the Health Secretary at the Royal College of GPs conference in which the Government launched a so-called Red Tape Challenge with NHSE to cut down on bureaucracy and free up GPs’ time to spend with patients.

DAUK’s GP Committee welcomed his focus on primary care but said the solutions needed input from GPs.

The committee also called on Mr Streeting to tone down the ‘negative rhetoric’ around general practice which was ‘encouraging resentment towards GPs’.

Urgent attention

Dr Lizzie Toberty, DAUK GP lead, said: “The interface between primary and secondary care is problematic and needs urgent attention.

“While Mr Streeting has understood the diagnosis, the treatment is wide of the mark and would benefit from input from GPs on the ground rather than managers in Whitehall.

“Negative rhetoric from Mr Streeting is not helpful and encourages public resentment towards GPs, who are desperately trying to do their best for their patients in a failing system.

“It also compounds the low staff morale highlighted in Lord Darzi’s recent report.”

Dr Ellen Welch, DAUK vice-chair, said proper funding for general practice to meet demand, which is at an all-time high, to retain and recruit GPs, and stop the closing down of practices should be the priority for the Government when it comes to primary care.

She said: “In England, the number of medical staff working in hospitals has increased by thousands – 163 per cent more consultants over the past 25 years – while general practices have closed in their hundreds, and the primary care workforce is shrinking with almost 2,000 fewer GPs than we had in 2015.

Demand

“Despite this, demand is high, and an average of 1.4 million GP appointments per working day were delivered between March 2023 and February 2024.

“On top of this, GPs are being expected by hospital teams to perform additional work for free. Every day, general practices across the UK receive letters asking GPs to kindly complete an array of unfunded tasks.

“Referral forms are a small part of our daily red tape but much more time is spent dealing with unfunded requests from secondary care such as ordering and chasing blood tests and investigations; providing fit notes or prescriptions for patients who have been seen in hospital; referring patients to another specialist; and chasing relatively small pots of money from ICBs.

“For the past decade, funding for hospitals has grown twice as fast as funding for general practice.

“Getting rid of a few referral forms will not revolutionise primary care, and on the whole GPs have taken the initiative to do this already.”

Collective action

The GP Committee also responded to Mr Streeting’s call for GPs in England to end collective action, with the Health Secretary saying he understood why doctors ‘wanted to give the previous government a kicking’.

GP spokesperson Dr Rosie Shire said: “Collective action is not about giving anyone a ‘kicking’. It is about doing what we are contracted and paid to do.

“No other section of society expects public or private sector workers to do work for free, and NHS general practice can no longer allow the service to run on goodwill when they are at risk of closing under the pressures.”

GP spokesperson Dr Sarah Jacques said investment was also needed in IT and estates to improve efficiency. Indeed, the Darzi review of the NHS found that ‘crumbling buildings hit productivity’ as well as impacted staff morale.

Dr Jacques said: “Primary care needs a fully-funded model with the promise of a long-term uplift to core funding.

“Buildings which are not fit for purpose and IT belonging somewhere in the last decade also need urgent attention.

“Only then will we see some meaningful change.”

Become a member of DAUK and support our work.

The committee says the report has ‘accurately identified many of the major issues facing general practice’, but said it was now keen to hear from the Government what the solutions would be.

Lord Darzi was commissioned by the new Government in July to conduct an immediate and independent investigation into the NHS, which DAUK gave evidence to.

In his report, Lord Darzi said ‘spending in primary and community settings had a superior return on investment when compared with acute hospital services’.

He said ‘therefore it makes sense that this should be the fundamental strategic shift that the NHS aspires to make’.

But he said that GPs do not have the resources or infrastructure to manage and coordinate the ‘increasingly complex care’ that was expected of them.

Major issues

Dr Lizzie Toberty, DAUK’s GP lead, said: “Lord Darzi accurately identifies many of the major issues including poor buildings, lack of IT and an over focus on hospital, rather than community care.

“As GPs we are heartened he recognises how under-resourced we have been and the inequity between primary and secondary care resourcing.

“Lord Darzi rightly points out GPs have been the most financially disciplined part of the NHS.

“General practice, more specifically, the partnership model has proven how efficient, innovative and agile it can be again and again.

Dr Toberty called for clarity from the Government as to how it intends to solve the problems.

General practice

DAUK’s GP committee issued a 10-point plan before the general election to relieve the pressure on general practice, which included a call for a cross-party group to make longer term decisions for the health service.

Dr Toberty said: “Lord Darzi has identified the problems in general practice quite accurately, but his report is missing solutions.

“The Prime Minister is advocating for reform but we are not clear as to what that means or what the reform will be but we would urge the new Government to take this opportunity to look at introducing cross-party collaboration.”

Dr Toberty said another solution was to fund general practice ‘without restriction on who GPs can employ’.

She said: “Lord Darzi notes that GPs are best placed to know the community they serve and what their patients need.

“The funding needs to go directly to practices for them to use for their patients, without restrictions on who can be employed. The report rightly states that additional roles, such as physios and pharmacists, should supplement GPs, not replace them.”

Patient trust

Dr Toberty added: “When it comes to general practice, the government must realise bigger is not better.

“There is huge efficiency to be gained when GPs have the ability and time to build up trust and continuity with their patients.

“The evidence shows this provides better outcomes, lower admissions and higher patient satisfaction.

“If the benefits of continuity of care were a drug we would put it in the water.

“But these problems are not insurmountable.

“We estimate a starting point is £2 billion to restore to 2015 levels of funding. This is a relatively modest investment of £35 per patient per year – or the cost of a cup of coffee a month.

“This is the time for the revival and rebirth of general practice. Give partners some resource, protect the model and there is still time to save the NHS.”

Our vice-chair Dr Ellen Welch, a GP in the north west of England, has written about the issues facing general practice in her book Why Can’t I See My GP?, a copy of which was sent to every MP before the general election to put NHS at the top of the agenda.

Read Lord Darzi’s report in full.

Support the work of DAUK, sign up as a member.